Throughout Viva‘s existence, I’ve heard a lot of commentary about therapy and how accessible it is – or more accurately, isn’t. People report being defeated by the process of finding a therapist (apparently there are people who don’t even respond to emails?!) and even once they do, they’re frustrated and confused about the cost. More often than not, the entire process leads to this inevitable question: “Why does no one take my insurance?!”.
There’s not enough communication.
Generally speaking, healthcare providers aren’t willing to educate their patients/clients about the healthcare system and what it entails. We could talk about why that might be, and I’m sure there are tons of valid reasons. Regardless, it all leads to the same place: really confused and frustrated people. We need to talk about it more because despite the frequent arguments, we’re all on the same side. I don’t know a single doctor, therapist, etc. who isn’t just as frustrated with the healthcare system in the United States as people seeking care. I’ll let the physical health side speak for itself, but in the effort of practicing what I preach, I want to be transparent about the side I can talk about.
First things first. Let’s call this Insurance 101.
For those who don’t know (and most don’t!), when you go to a doctor and the office bills your insurance, they aren’t just billing for one visit and calling a day. The billing department doesn’t send a form that’s like, “Hey, UnitedHealthcare. Maria came in today! One visit! Thanks!”. They actually have several services they can bill for within one visit, and they get paid for each one. If your doctor educates you on healthy eating, that’s one service. A chat about those headaches you keep having? That’s another. Some fun bloodwork? Yup, another service! If you ask about persistent sleep issues, that’s yet another. And so on and so forth.
They’re actually getting paid for several “services” within one visit – even if that visit only lasts 15-20 minutes. Think how many appointments your primary care physician books in an hour, and now think of how many services they’re billing. That’s a lot of services, and rightfully so. Doctors do great work and should get paid accordingly.
Now, let’s apply this to therapy.
We get one service. That’s it. We can’t bill for separate topics, suggestions, or concerns that we talk about in session. We can bill for one thing and that’s one session of therapy. On top of that, we don’t get to book four appointments in an hour. We book one, because most therapy sessions are 45 minutes long. Instead of multiple appointments with multiple paid services in that hour, we’re only being paid for one appointment and one service. Yup, I know. It sucks.
But wait, there’s more! Insurance companies pay a small portion of our “market rate” fee. What does that mean, you might ask? Let’s say a client comes in and pays out of pocket and pays a rate of $150 per session, for example. You might assume that a therapist would make the exact same amount of money if someone comes in wanting to bill insurance and the only difference is that the insurance company pays for it instead of the client. That would be GREAT, however, that’s totally wrong. Insurance companies might instead pay that therapist $75 dollars because that’s their “contracted rate”. Some might even pay $60. See where I’m going with this?
Even therapists who believe strongly in accessibility and affordability of services like to do things like pay rent and eat. When we’re paid half of what we’d normally charge (and are worth!), that’s often just not possible. As a result, you get a lot of therapists who have limited insurance slots or don’t take insurance at all.
WAIT! There’s still more. Let’s move on to Insurance 102.
Show of hands who has had to ever contact their insurance company. Yes, I hope you are actually raising your hand wherever you’re reading this. Now, keep your hand up if you had a pleasant experience with that phone call. Right. I can’t see you, obviously, but I’d be shocked if you’re still raising your hand. Calling insurance companies is awful and I’m lucky enough to know from both personal and professional experience.
This is why a lot of medical practices hire people to deal with just this. There are billing departments for a reason. You need to pay people an entire salary just to deal with this insanity.
BUT – remember what we talked about with the discrepancy between what an insurance company will pay a doctor versus a therapist? Therapists can’t afford to pay billing department employees, so if there’s any discrepancy or issue in getting paid, it’s up to us to call. The problem is we’re filling up our schedules to make ends meet, so when should that call happen? It can take hours (yes, really) to resolve an issue. Because of this, a lot of claims (the paperwork we send to an insurance company) end up going unpaid. COOL.
So what does all of this mean? Why am I even sharing this?
Don’t worry, it’s not to make you feel bad for therapists. I love my job! I think it’s important that we all understand the reality of both sides of the situation. The enemy isn’t the therapist who won’t accept your insurance. This is most likely why, rather than a principled stance against your insurance plan. It’s not a picnic for anyone. More and more medical providers are also opting to not take insurance directly because of the logistical headache I described above. Insurance companies can also place restrictions on the care you give someone, including the amount of time you can be paid for and how long appointments will be covered. It’s exhausting and it’s so counterintuitive to quality care. It’s a huge problem.
So what can I do?
Thank you for asking! While there’s no quick fix, understand that this is what healthcare providers and those who attempt to use their insurance regularly go through. Acknowledge the real problem of a broken healthcare system in this country, not a single provider who wants you to pay out of pocket.
VOTE. Vote for candidates who also recognize this issue. Call your representatives. Talk to friends and family and educate them on why this is a huge issue for so many of us.
In the moment, take advantage of your company’s HSA or FSA plans that allow you to put pre-tax money to pay for any out of pocket medical or mental health expenses. Look for providers who offer sliding scale fees or payment plans. Plan to pay something out of pocket, as infuriating as it may be, for healthcare expenses until this country gets its act together and has some type of universal healthcare system.